• Korean Journal of Radiology
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• 제22권3호
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• pp.395-404
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• 2021

Objective: To compare the utility of computed tomography perfusion (CTP) and three different 4-point scoring systems in computed tomography angiography (CTA) in confirming brain death (BD) in patients with and without skull defects. Materials and Methods: Ninety-two patients clinically diagnosed as BD using CTA and/or CTP for confirmation were retrospectively reviewed. For the final analysis, 86 patients were included in this study. Images were re-evaluated by three radiologists according to the 4-point scoring systems that consider the vessel opacification on 1) the venous phase for both M4 segments of the middle cerebral arteries (MCAs-M4) and internal cerebral veins (ICVs) (A60-V60), 2) the arterial phase for the MCA-M4 and venous phase for the ICVs (A20-V60), 3) the venous phase for the ICVs and superior petrosal veins (ICV-SPV). The CTP images were independently reviewed. The presence of an open skull defect and stasis filling was noted. Results: Sensitivities of the ICV-SPV, A20-V60, A60-V60 scoring systems, and CTP in the diagnosis of BD were 89.5%, 82.6%, 67.4%, and 93.3%, respectively. The sensitivity of A20-V60 scoring was higher than that of A60-V60 in BD patients (p < 0.001). CTP was found to be the most sensitive method (86.5%) in patients with open skull defect (p = 0.019). Interobserver agreement was excellent in the diagnosis of BD, in assessing A20-V60, A60-V60, ICV-SPV, CTP, and good in stasis filling (κ: 0.84, 0.83, 0.83, 0.83, and 0.67, respectively). Conclusion: The sensitivity of CTA confirming brain death differs between various proposed 4-point scoring systems. Although the ICV-SPV is the most sensitive, evaluation of the SPV is challenging. Adding CTP to the routine BD CTA protocol, especially in cases with open skull defect, could increase sensitivity as a useful adjunct.

• Journal of Korean Neurosurgical Society
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• 제58권6호
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• pp.513-517
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• 2015

Objective : Microscopic indocyanine green (ICG) angiography is useful for identifying the completeness of aneurysm clipping and the preservation of parent arteries and small perforators. Neuroendoscopy is helpful for visualizing structures beyond the straight line of the microscopic view. We evaluated our prototype of endoscopic ICG fluorescence angiography in swine, which we developed in order to combine the merits of microscopic ICG angiography and endoscopy. Methods : Our endoscopic ICG system consists of a camera, a light source, a display and software. This system can simultaneously display real-time visible and near infrared fluorescence imaging on the same monitor. A commercially available endoscope was used, which was 4 mm in diameter and had an angle of $30^{\circ}$. A male crossbred swine was used. Results : Under general anesthesia, a small craniotomy was performed and the brain surface of the swine was exposed. ICG was injected via the ear vein with a bolus dose of 0.3 mg/kg. Visible and ICG fluorescence images of cortical vessels were simultaneously observed on the display monitor at high resolution. The real-time merging of the visible and fluorescent images corresponded well. Conclusion : Simultaneous visible color and ICG fluorescent imaging of the cortical vessels in the swine brain was satisfactory. Technical improvement and clinical implication are expected.

• Investigative Magnetic Resonance Imaging
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• 제14권1호
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• pp.10-20
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• 2010

목적: 최근, 미국 애리조나 세도나에서 열린 국제자기공명학회 (ISMRM) 주관의 2009년 데이터 샘플링과 영상 복원에 관한 워크샵에서 자기공명영상 복원 대회가 열렸다. 이 대회는 time resolved contrast enhanced MR angiography 에 대한 고속 촬영의 실제 활용 가능성을 평가하기 위한 것이었다. 본 논문은 이 대회의 우승 결과를 얻은 k-t FOCUSS 알고리듬을 단계별로 자세히 묘사하도록 한다. 대상 및 방법: 본 그룹은 앞선 연구에서 비교적 덜 스파스한 심장 영상에 대해 k-t FOCUSS 알고리듬이 성공적으로 압축센싱 문제를 풀수 있음을 증명했다. 따라서 k-t FOCUSS 알고리듬을 time resolved contrast enhanced MR angiography 에 적용함으로써, 매우 정확한 영상 복원이 가능할 것이다. 영상 복원을 위해 X-ray 대뇌 혈관조영 영상으로부터 구성된 다운 샘플링된 데이터가 대회 주최측으로부터 공통으로 제시되었고, 방사선과 의사들이 각 복원된 영상에 대한 사전 정보 없이, 원래 영상과 복원된 결과를 비교함으로써, 영상의 질을 평가하였다. 결과: 다양한 다운샘플링에 대해 얻어진 결과들은 영상의 스파스 변환이나 샘플링 형태와 같은 압축센싱의 중요한 요소들에 의해 크게 영향을 받는다는 것을 보여주었다. 결론: 복원된 결과로부터, 압축센싱 동적자기공명영상 기법인 k-t FOCUSS 가 고해상도의 time resolved contrast enhanced MR angiography 를 가능하게 할 수 있음을 확인하였다.

• 대한영상의학회지
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• 제81권5호
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• pp.1053-1068
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• 2020

문재인 정부의 새로운 건강보험 보장성 강화 대책에 따라 2018년부터 뇌 MRI, 뇌혈관/경부혈관 MRA, 두경부 MRI 급여가 확대되어 시행 중이다. 2018년 10월부터 2020년 4월까지 개정되어 현재 시행 중인 MRI 급여와 관련된 '요양급여의 적용기준 및 방법에 관한 세부사항'을 중심으로 정리해 보았다. 이 종설은 MRI 요양급여체계, 두통, 어지럼증 환자의 급여기준조정, 뇌 MRI, 뇌혈관/경부혈관 MRA, 두경부 MRI의 급여기준, 표준영상, 판독소견서 등을 포함하였다. 이 글을 통해 영상의학과 전문의가 보험 영역에서도 전문적인 지식을 갖추어 영상의학과 전문의의 전문성을 확보하고, 소속병원에서 주도적인 역할을 하는데 도움이 되고자 한다. MRI 급여화 확대 정책이 진행 중으로 관련 보건복지부의 세부고시가 개정될 수 있다. 따라서 MRI와 보험과 관련된 사안을 지속적으로 업데이트하는 것이 요망된다.

• Journal of Korean Neurosurgical Society
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• 제42권1호
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• pp.49-52
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• 2007

The authors report a unique case of unilateral Moyamoya disease with a rare combination of arteriovenous malformation (AVM) who presented with intracerebral hemorrhage (ICH). A 50-year-old man suffered from sudden onset of mental deterioration and right hemiparesis. Brain computed tomography (CT) showed intracerebral hemorrhage on left thalamus. Brain CT angiography and cerebral digital subtraction angiography (DSA) revealed AVM combined with unilateral moyamoya disease involving left middle cerebral artery (MCA) and choroid plexus in left lateral ventricle. Intraventricular hemorrhage and hydrocephalus were managed conservatively. A rare case of unilateral Moyamoya disease accompanied by a cerebral arteriovenous malformation is described and discussed with review of pertinent literature.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.428-430
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• 2014

Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.

• 한국정보과학회논문지:소프트웨어및응용
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• 제30권9호
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• pp.821-828
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• 2003

본 논문은 경동맥(carotid artery)을 환영한 MRA(Magnetic Resonance Angiography) 영상을 이용하여 실제 내시경으로 접근이 불가능한 경동맥의 내부를 시각화(visualization)하기 위해 가상혈관경(virtual angioscopy)을 구현하였다 항해경로 결정을 위해 MRA의 단면 원천영상에서 총경동맥 (common carotid artery) 및 내경동맥(internal carotid artery)만을 분리하였고, 중앙축 변환(MAT Medial Axis Transformation)을 통해 구해진 좌표값을 가상 카메라의 운행 경로로 사용하였다. 원근투영 (perspective projection) 및 볼륨 데이타의 표면을 렌더링하기 위해 마칭큐브(marching rube) 알고리즘을 사용하였다 허혈성으로 인한 뇌혈관질환(cerebrovascular disease)은 뇌졸중(stroke)의 80% 정도를 차지하는데, 경동맥은 뇌에 혈액을 공급하는 주된 혈관으로 경동맥 협착증(carotid artery stenosis)은 뇌졸중의 직접적인 원인이 된다. 가상혈관경은 경동맥 내부의 협착 위치와 협착 정도를 정성적으로 파악 할 수 있으며 협착증의 진단과 교육에 사용될 수 있다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.117-118
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• 1998

The aim of this work is to develop 3-D stereotactic localization system in order to determine the precise shape, size and location of the lesion in the brain in the field of Stereotactic Radiosurgery(SRS) and neurosurgery using CT/MRI/angiography and multi-purpose QA phantom. The algorithms to obtain a 3-D stereotactic coordinates of the target have been developed, and targets on each CT image were superimposed each other on MR/angiography images without distortion corretion. This system was implented in Visual C++ as a PC-based application program.

• 동의생리병리학회지
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• 제21권2호
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• pp.578-581
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• 2007

Moyamoya disease is characterized by the angiographic findings of bilateral occlusion of the distal portion of the internal carotid arteries with a vascular network at the base of the brain. The typical findings on conventional angiography and magnetic resonance imaging usually confirm the correct diagnosis of moyamoya disease. We experienced a 11-year-old girl with moyamoya disease showing repeated transient ischemic attacks and we report on this case with a review of the literature.

• 대한핵의학회:학술대회논문집
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• 대한핵의학회 1970년도 제9차 학술대회
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• pp.83.1-83.1
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• 1970